CMCNZ Expense Claim Form

MYF Committee

Expenses Claim Form
Personal Details
Name*

TitleFirst NameLast Name
Email*
example@example.com
Date*

DayMonthYear
Date Claim Submitted
Please pay Claim to:*

Myself, I've paid or claiming on behalfDirect to the external supplierOther
Bank Account Name (if different above)
Bank Account Number*
Suffix is 3 digits. Add a 0 in front if only 2 digits
Bank Reference (if required)
Expenses Details
Group*
Select the Group the claim is for. If you are claiming for multiple Groups, please submit a separate Claim Form for each Group
Expenses details*

Expenses list*

Total Claim Amount (NZD)
Please check if this equals the total amount of your claim
Tick if the amount to claim is different

The same as aboveDifferent from above
Adjusted Claim Amount (NZD)
Use this if there is a upper limit to your claim
Please submit your claim in NZD only. For expenses in foreign currency, please convert using XE.com and attached the screenshot of the conversion - Click here for XE Currency Converter. If paid using NZ credit card/bank account, use the NZD amount from your statements as the claim amount and attach as proof.
Receipt Upload*

Scan or take a photo of your receipt and upload
Cancelof
Claimant Signature*

Clear
Should be Empty:

MYF Committee